D-二聚体联合游离三碘甲状腺原氨酸对急性心肌梗死预后的预测价值研究

The predictive value of prognosis of D-dimer combined with free triiodinothyroiine for acute myocardial infarction

目的:探讨患者入院24h内首次D-二聚体(D-dimer)和游离三碘甲状腺原氨酸(FT3)对急性心肌梗死(AMI)预后的预测价值。方法:检索2011-01-01—2018-12-31期间我院心内科收治的AMI患者的病例资料,记录一般情况(性别、年龄、入院时生命体征及基础疾病)及来院后首次检查结果,包括血常规、心肌损伤标志物、肝肾功能、血脂、电解质、心动图及心脏彩超等相关指标,根据多因素Logistic回归分析结果绘制受试者工作特征曲线(ROC曲线)和拟合曲线,分析患者来院24h内D-dimer联合FT3与AMI院内死亡的相关性。结果:死亡组与好转组相比,D-dimer明显升高[(5.54±2.95)mg/Lvs.(0.41±2.26)mg/L,P<0.01],FT3明显降低[(2.02±0.54)pg/Lvs.(2.75±0.42)pg/L,P<0.01]。根据Logistic回归分析结果绘制ROC曲线,D-dimer、FT3的曲线下面积分别为0.848,0.728,利用多因素分析,将D-dimer与FT3进行拟合后绘制ROC曲线下面积为0.850(P<0.01),以0.80为截点,敏感度0.743,特异度0.839,提示两者联合评价效果优于单一因素。结论:入院24h内首次D-dimer及FT3与AMI患者的早期预后相关,D-dimer升高同时合并FT3降低的AMI患者病情更严重,预后更差。

Objective: To explore the predictive value of D-dimer combined with free triiodothyroiine(FT3) for the prognosis of acute myocardial infarction(AMI) during hospitalization. Method: To retrieve the medical records of the AMI of our hospital from January 1, 2011 to December 31, 2018. The general conditions and results of the first examination are recorded(gender, age, vital signs at admission and underlying diseases after admission), Including blood routine, myocardial injury markers, liver and kidney function, blood lipids, electrolytes, echocardiography and heart color doppler ultrasound and other related indicators. Based on the results of multiple Logistic regression analysis, the ROC curve and the fitting curve are plotted to analyze the correlation between D-dimer combined with FT3of the hospital deaths of AMI within 24 hours. Result: D-dimer is significantly increased in the death group compared with the alleviative group[(5.54±2.95)mg/L vs.(0.41±2.26)mg/L, P<0.01], FT3is decreased significantly[(2.02±0.54)pg/L vs.(2.75±0.42)pg/L, P<0.01]. The ROC curve is plotted according to the results of Logistic regression analysis. the AUC areas under the curve of D-dimer and FT3are 0.848 and 0.728. Using multivariate analysis, the area under the ROC curve is 0.850(P<0.01) after fitting D-dimer with FT3, The cut-off point is 0.80, the sensitivity is 0.743, and the specificity is 0.839. That means the effectiveness of the combined evalution is superior to either single factor. Conclusion: The first D-dimer and FT3within 24 hours of admission are associated with the early prognosis of AMI, AMI patients with increased d-dimer and decreased FT3have more severe disease and worse prognosis.